Care After Bone Grafting
The following information applies when grafting material has been placed into extraction sites or other areas to help preserve or reconstruct your upper and/or lower jaws in preparation for implant replacement.
Your bone graft is typically particulate bone and is much the consistency of course sand. As a result, you may find some small granules in your mouth for the first several days. Do not be alarmed. It is normal to have some of these granules periodically come out of the graft site and into your mouth. You can do some things to minimize the amount of particles that become dislodged:
- Do not disturb or touch the wound.
- Avoid rinsing or spitting for 2 days to allow blood clot and graft material stabilization.
- Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
- Do not constantly lift or pull on the your lip to look at the sutures. This can actually cause damage to the wound, dislodge the membrane, or tear the sutures.
- Do not smoke if possible for at least two weeks.
- Following the second day, gentle rinsing would be allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial or full denture was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor.
Be sure to take the prescribed antibiotics as directed to help prevent infection.
Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound, possibly dislodge the membrane, and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.
Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start warm saltwater rinses the day following your procedure. Use one-half teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking a few minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next five days.
Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle. We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex) for certain procedures. This rinse should be used at least in the morning and at bedtime after routine mouth care. Frequently, you can use this medication on a cotton-tipped applicator, gently wiping the membrane and surrounding area, to minimize staining of your teeth. Do not eat, drink, or rinse your mouth after using the medicated rinse for at least 30 minutes. Using this rinse as an oral rinse more than two times a day will cause staining of your teeth.
REMEMBER: A clean wound heals better and faster.
Do not smoke for at least two weeks after surgery, if at all. As discussed at your consultation, smoking dramatically increases the risk of bone graft and sinus augmentation failure. We can prescribe a Nicoderm patch if you feel you need it.
Wearing your Prosthesis or Night Guard
Partial dentures or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. When it is placed it should not heavily touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft. If you have questions about the fit of your partial or complete denture, do not wear it until your general dentist or Drs. Elias, Stephens or Verratti can see you.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon for 24 hours or more. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery, inflammation, and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. The swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on 20 min’s then off 20 min’s for the first 12 – 24 hours. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-four 200 mg tablets (600 – 800 mgs) may be taken every 6 hours.
For severe pain, take the medication prescribed as directed (typically narcotic medication). The prescribed narcotic pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
After general anesthesia or I.V. sedation, liquids should be initially taken. Do not use straws for the first 24 hours. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Please refer to the section on suggested diet instructions at the end of this section. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss meals. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for several moments before standing.
Discoloration & Bruising
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a rare but normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Nausea and Vomiting
n the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on clears liquids such as flavored waters, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking soft foods and the prescribed medicine. If your nausea continues for more than 6 hours, please contact Drs. Elias, Stephens or Verratti.
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Drs. Elias, Stephens or Verratti if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If your fever persists, notify our office. Tylenol or ibuprofen should be taken to reduce the fever.
You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids after surgery. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for a few moments then get up.
If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline or other lip balms.
Sore throats and pain when swallowing are not uncommon. The muscles adjacent to the surgical sites can become inflamed and subsequently give some discomfort during swallowing. This will subside in 2-3 days.
Stiffness (trimus) of the jaw muscles may cause some difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event, which will resolve typically in several days.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. These sutures are frequently dissolving sutures, which will typically fall out in 5 – 7 days. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. So it’s really nothing to worry about.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising or reduce your exertion. Do not assume up-side-down positions for 1 – 2 weeks.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions. In the mean time, the area should be kept clean especially after meals with saltwater rinses or a toothbrush.
Remember, your case is individual and no two mouths are alike. Try not to accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you, Drs. Elias, Stephens or Verratti.